Modifier Use for Bilateral Hernias Done Weeks Apart

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September 15, 2016

Question:
The doctor performed a right inguinal hernia repair followed by a left inguinal hernia repair six weeks later. I know a modifier will be needed on the second surgery but I’m unclear as to which one to use. Is this a staged procedure?

Answer:
You are correct that a modifier will be needed on the second procedure since inguinal hernia repair (4xxxx open xxxxx, laparoscopic) both have 90 day global periods. Although the surgeons staged these procedures by scheduling them weeks apart, the fact that the procedures are at different anatomic sites, right and left, makes the second procedure “unrelated” to the first. Modifier 79 is appended to the second procedure. The diagnosis codes will be the same for both procedures since under ICD-10, as in ICD-9, the code for inguinal hernia is described as unilateral and not as right or left.

*This response is based on the best information available as of 09/15/16.

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